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AJCP / SPECIAL ARTICLE
Recommendations for the Reporting of Prostate
Carcinoma
Association of Directors of Anatomic and Surgical Pathology*
DOI: 10.1309/59U8R6N5R7BKCWLV
ADASP Reporting Guidelines
It has been evident for decades that pathology reports are
very variable even within a single institution. Standardization
of reporting is the optimal way to ensure that information necessary for patient management, prognostic and predictive factor assessment, grading, staging, analysis of outcomes, and
tumor registries is included in pathology reports.
The Association of Directors of Anatomic and Surgical
Pathology (ADASP) has chosen a pathologist expert in each
field to assemble a group from within the pathology community (with clinician input if desired) to write specific cancer
protocols. These were then approved by the ADASP council
and subsequently by the membership. The American College
of Surgery (ACS) Commission on Cancer (COC) accredits
cancer centers in the United States. Recently, the COC
decided to require elements, deemed as essential by the
College of American Pathologists (CAP), to be described in
all pathology reports in their accredited cancer centers as of
January 2004. It is important to note that the COC does not
require that the specific CAP protocols or synoptic reports
be used. The ADASP has updated all of its protocols to comply with the COC requirements in the form of uniform
checklists. The checklists use the staging criteria cited in the
American Joint Committee on Cancer 2002 staging manual
(sixth edition) but include a variety of other references listed
in each of the checklists. Moreover, the checklists are formatted for ease of use. They may be used as templates for
uniform reporting and are designed to be compatible with
voice-activated transcription.
The different elements in these revised ADASP diagnostic checklists have been divided into required and optional.
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The term required in this context only signifies compliance
with the COC guidelines. The ADASP realizes that specimens
and practices vary and it will not be possible to report these
elements in every case. However, the ADASP hopes that
pathologists will find these checklists to be useful in daily
clinical practice, while facilitating compliance with the new
COC requirements.
The checklists are in standard PDF file format and may
be easily downloaded from the ADASP Web site. They are not
to be reproduced, altered, or used for commercial purposes
without consent from ADASP.
Christopher N. Otis, MD
Editor, ADASP Practice Guidelines
I. Features the Association (ADASP) recommends to be
included in the final report because they are generally
accepted as being of prognostic importance, required for
therapy, and/or traditionally expected
A. Gross description
1. Description of specimen received: fresh, in formalin,
intact, cut, margins inked or not, etc
2. Specimen labeling: labeled with (name, number),
designated as prostate, and procedure (core biopsy,
transurethral biopsy, transurethral resection of the
prostate [TURP], enucleation, radical prostatectomy,
radical cystoprostatectomy, other)
3. Size: The overall size of the excised specimen should
be measured in 3 dimensions: TURP specimens
should be weighed; needle biopsy cores should be
counted and measured in length (state if multiple
small fragmented cores without need for measuring)
© American Society for Clinical Pathology
AJCP / SPECIAL ARTICLE
4. Additional organs attached: eg, seminal vesicles, vasa
deferentia, bladder neck in radical prostatectomy
specimens
5. Tumor description
• Presence of lesion(s) or absence of lesion(s)
• Location of the lesion(s) (eg, in radical
prostatectomy: posterior, posterolateral, lateral,
anterior and apex, mid, base)
• Size of the lesion(s) (greatest diameter if radical
prostatectomy)
• Consistency of the lesion(s) (eg, firm, fleshy)
6. Lymph nodes: number and appearance of lymph
nodes if received
7. Frozen section: whether a frozen section was
performed and the diagnosis that was made
B. Diagnostic information
1. Histologic type
___ Adenocarcinoma (acinar, not otherwise specified)
___ Prostatic duct adenocarcinoma
___ Mucinous (colloid) adenocarcinoma
___ Signet-ring cell–like carcinoma
___ Adenosquamous carcinoma
___ Small cell carcinoma
___ Sarcomatoid carcinoma
___ Undifferentiated carcinoma, not otherwise specified
___ Other (specify): __________________________
2. Histologic grade: All acinar adenocarcinomas
should be graded using the Gleason grading system.1-4
Ductal adenocarcinomas are typically assigned a
Gleason score of 4 + 4 = 8 yet are diagnosed as
“ductal adenocarcinoma (Gleason score 4 + 4 = 8)” to
convey the unique clinical and pathologic features
of this tumor. There is no consensus as to the grading
of mucinous carcinomas. Approximately one half of
urologic pathologists grade them as Gleason pattern 4
(eg, Gleason score 4 + 4 = 8 if pure mucinous tumor).
The remaining experts grade the tumor based on the
underlying tumor architecture, mentally subtracting
away the mucin. Regardless of the method used to
grade mucinous carcinomas, the majority of these
tumors end up being assigned a Gleason score 4 + 4 = 8.
True signet-ring cell carcinomas containing vacuoles
of mucin that are primary in the prostate are
exceedingly rare. Rather, there exist signet-ring
cell–like carcinomas, which contain clear vacuoles
without mucin. These tumors are graded by their
underlying architecture. Small cell carcinomas are not
graded as they have unique clinicopathologic features
and, most important, are treated differently from
Gleason pattern 5 adenocarcinomas. The carcinomatous
component of sarcomatoid carcinoma and adenosquamous carcinoma should be assigned a Gleason score.
For all types of specimens (needle, TURP,
enucleation, radical prostatectomy), when there is a
minor secondary component (<5% of tumor) and
where the secondary component is of higher grade,
the latter should be reported. For example, a case
showing more than 95% Gleason pattern 3 and less
than 5% Gleason pattern 4 should be reported as
Gleason score 3 + 4 = 7. Conversely, if a minor
secondary pattern is of lower grade, it need not be
reported. For example, when there is more than 95%
Gleason score 4 and less than 5% Gleason 3, the
score should be reported as Gleason score 4 + 4 = 8.
These aggressive cases with only a few glands of
Gleason pattern 3 should be distinguished from cases
with a more prominent secondary Gleason pattern 3,
which are assigned a Gleason score of 4 + 3 = 7.
In needle biopsy specimens, it is recommended
that separate Gleason scores be assigned for each
specimen container. This is most critical for situations
in which the grade for the tumor in one container is
Gleason score 4 + 4 = 8 and the others are of lower
grade. In these cases, the tumor behaves according to
the highest grade (eg, Gleason score 4 + 4 = 8) and
not the composite (overall) score, which would be
lower. Further support for assigning separate Gleason
scores for different containers is that the Gleason
grade factored into currently existing tables and
nomograms (eg, Partin tables and Kattan
nomograms), which predict the stage and prognosis of
prostate cancer, used the highest Gleason score in a
case and not the composite (global) score. Providing a
global or composite score reflecting the overall
Gleason score in the entire specimen is optional.
In needle biopsy specimens in which more than
2 patterns are present and the worst grade is neither
the predominant nor the secondary grade, the
predominant and highest grade should be chosen to
arrive at a score (eg, 75% pattern 3, 20% pattern 4,
and 5% pattern 5 is assigned a Gleason score of 3 + 5
= 8). It is assumed that a minor component of highgrade cancer in needle biopsy specimens represents a
sampling artifact in which it is likely that there will be
a significant amount of the high-grade cancer in the
prostate.
In TURP or enucleation specimens in which one
cannot identify separate tumor nodules, only 1
Gleason score is assigned. In radical prostatectomy
specimens, each dominant tumor nodule is assigned a
separate Gleason score. It is not necessary to assign a
separate score to each small, multifocal, low-grade
cancer focus in the setting of a larger, higher-grade
dominant nodule. When there is no dominant tumor
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ADASP / REPORTING PROSTATE CARCINOMA
nodule, it can be stated that there are multifocal tumor
nodules with a comment as to their grades. In TURP,
enucleation, and radical prostatectomy specimens, the
Gleason score is based on the primary (most
common) and secondary (next most common) pattern.
If there is a third pattern or if the second pattern
occupies less than 5% of the specimen, then this
pattern is reported as a tertiary pattern.
3. Tumor extent: In core biopsy specimens, the absolute
number of involved cores should be reported out of
the total number of cores received.5 In cases with
fragmented cores in which one cannot accurately
derive the number of involved or total number of
intact cores, one can merely state the overall
percentage of the fragmented specimen involved by
cancer. In addition, one should provide one other
more detailed measurement of cancer, such as the
linear extent of involvement in millimeters (per core
or total) or the percentage of cancer in each involved
core. There is no consensus whether one should give
the linear extent or percentage of involved core by
counting gaps of uninvolved tissue in the
measurement or by “collapsing” the tumor by
ignoring the intervening gaps of benign tissue.
Because different foci of cancer along a core most
likely represent the same tumor as opposed to
multifocal cancer, it is preferred to record the tumor
extent, including the uninvolved tissue in the
measurement because it more accurately represents
the minimal extent of the cancer in the prostate. To
distinguish small discontinuous foci from continuous
cancer, one can report the following: “Small foci of
cancer discontinuously involving X% of the length of
the core,” where “X” is measured from one end of the
cancer to the other on the core regardless of
intervening benign tissue.
In TURP and enucleation specimens, the
percentage of tissue involved by carcinoma is reported,
with 5% the cutoff between T1a and T1b disease.
There is no uniform data that tumor volume in
radical prostatectomy specimens is an independent
predictive parameter of prognosis once other standard
parameters are recorded.6-8 Nevertheless, it is
recommended that some measurement of tumor
volume be recorded even if it is a subjective
quantification of minimal, moderate, or extensive. If
more precise measurements are required by the
clinician, an “eyeball” estimate of the percentage of
the specimen involved by cancer is sufficient.
4. Margins of resection: The entire surface of a radical
prostatectomy specimen should be inked to evaluate
the surgical margins.6-8 Usually, surgical margins
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should be designated as “negative” if tumor is not
present at the inked margin and as “positive” if tumor
cells touch the ink at the margin. When tumor is
located very close to an inked surface but is not
actually in contact with the ink, it is considered
negative. Positive surgical margins should not be
interpreted as extraprostatic extension. Intraprostatic
margins are positive in the setting of capsular incision
(so-called pT2+ or pT2x disease). The specific
locations of the positive margins are useful to report,
and there should be some indication of the extent of
margin positivity (eg, unifocal vs multifocal or focal
vs extensive or number of positive sites [blocks] or
linear extent in millimeters).
The apical and bladder neck surgical margins
should be submitted entirely, preferably with a
perpendicular sectioning technique.9 Microscopic
involvement of bladder neck muscle fibers in radical
prostatectomy specimens should not be equated with
a pT4 designation. The latter generally requires gross
involvement of the bladder neck. It has been shown
that patients with microscopic bladder neck
involvement have recurrence rates similar to patients
with seminal vesicle involvement (pT3b).10
5. Extraprostatic extension (EPE): This is the preferred
term for the presence of tumor beyond the confines of
the prostate gland.11 Tumor abutting or admixed with
fat constitutes EPE and, in general, is the only method
to reliably diagnose EPE on needle biopsy. However,
if one relies on the identification of tumor in fat to
diagnose EPE in radical prostatectomy specimens,
EPE will be underdiagnosed. One should also
diagnose EPE when tumor extends beyond the
condensed smooth muscle of the prostate to involve
the looser connective tissue and thinner, less compact
smooth muscle outside the prostate. One can also use
the overall scanning magnification to assess whether
tumor has extended beyond the normal contour of the
gland. Reporting EPE at the apex is controversial
because the boundaries of the prostate gland in this
region are vague; benign prostatic acini are seen
admixed with skeletal muscle in this region. One
option is merely to state whether tumor is present and
whether the margins are positive or negative in the
apical region, while not attempting to determine if
tumor is organ-confined in this area.
The other option is to assume that the urologist
has gone as widely as possible and the inked margin
at the apex is outside the prostate. Tumor not
extending to the ink is considered organ-confined, and
tumor at the inked margin is considered as showing
EPE, unless benign prostatic glands are also seen at
© American Society for Clinical Pathology
AJCP / SPECIAL ARTICLE
6.
7.
8.
9.
10.
the inked margin whereby capsular incision is
diagnosed. The specific location(s) of EPE are useful
to report. Descriptors of EPE (unifocal vs multifocal,
focal vs nonfocal, focal vs extensive, linear
millimeters, or number of blocks) may be used.
Lymph node status: Indicate the number of nodes
involved and the total number of nodes evaluated.
Angiolymphatic invasion: This finding is
independently predictive of prognosis in radical
prostatectomy specimens and should be recorded. The
Association does not recommend the routine use of
immunohistochemical stains to detect intravascular
invasion.
Perineural invasion: Perineural invasion in needle
biopsy cores has been associated with EPE in most
correlative radical prostatectomy studies, although its
value as an independent prognostic factor has been
questioned. Perineural invasion has been found to be
an independent risk factor for predicting an adverse
outcome in patients treated with external beam
radiation.12 Because it is easily measured and appears
to have prognostic significance on biopsy, regardless
of whether it is an independently prognostic
parameter, its presence should be recorded for needle
biopsy specimens. Perineural invasion has no
prognostic significance in radical prostatectomy
specimens and should not be mentioned in the
pathology report.
Prostatic intraepithelial neoplasia (PIN): Generally,
low-grade PIN is not reported. The presence of
isolated high-grade PIN (HPIN) should be reported in
all biopsy specimens. The risk of cancer on repeated
biopsy within 1 year of a needle biopsy diagnosis of
HPIN is not sufficiently different from the risk of
cancer on repeated biopsy following a benign
diagnosis on needle biopsy.13 Consequently, immediate
repeated biopsy following a needle biopsy diagnosis
of HPIN is not necessary. Whether and when a
repeated biopsy should be performed remains to be
studied. The reporting of HPIN in prostatectomy
specimens is optional.
Staging: It is necessary to provide the TNM staging
for radical prostatectomy specimens. The subdividing
of pathologically organ-confined disease whether the
tumor involves less than half of one lobe (pT2a),
involves more than half of one lobe (pT2b), or
involves both lobes (pT2c) has been criticized. This
aspect of the staging system will be changed in future
revisions, and many urologic pathologists do not
subdivide pT2 tumors using the current system.
Adenocarcinoma of the prostate is multifocal in more
than 85% of cases. In many of these cases of bilateral
and/or multifocal tumor, the other tumors are small,
low-grade, and clinically insignificant. Consequently,
the distinction between pathologic stages T2a and T2c
may reflect several very different conditions: (1) a
large single tumor nodule involving both sides, (2)
separate large tumor nodules on each side, (3) a
dominant nodule on one side with multifocal minute
tumor on the other side, or (4) bilateral minute
multifocal tumor. Prognostically, there are no
differences between the subdivisions of pT2.14-16
Stage pT2b tumor almost never exists, as it is almost
impossible for a tumor to involve more than half of
the lobe without involving the other lobe. However,
using the current staging system for subdividing pT2
tumor remains an option. It is now recommended by
the ACS and will be updated in the new TNM Staging
System such that pathologists do not fill in a “pM”
(metastasis) category because that is the domain of
the clinician.
11. Submission of tissue for microscopic evaluation in
TURP and radical prostatectomy specimens8: TURP
specimens should be sampled with 8 cassettes. In a
younger man (eg, <65 years old), consideration
should be given to more extensive sampling. Some
experts suggest submitting additional cassettes based
on the weight of the TURP specimen. In general,
random chips are submitted. If an unsuspected
carcinoma is found in tissue submitted and it involves
5% or less of the tissue examined, the remaining
tissue is generally submitted for microscopic
examination, especially in younger patients.
Radical prostatectomy specimens may be totally
submitted or partially sampled in a systematic
manner. For partial sampling in the setting of a
grossly visible tumor, the sections with visible tumor
along with the entire apical and bladder neck margins
and samples from the base of each seminal vesicle
should be submitted. If there is no grossly visible
tumor, a number of systematic sampling strategies
may be used. One that yields excellent prognostic
information involves submitting the posterior aspect
of each transverse slice along with a mid anterior
block from each side. The anterior sampling detects
tumors that predominantly involve the transition zone.
The entire apical and bladder neck margins and base
of each seminal vesicle should also be submitted.
*
Committee members: Jonathan I. Epstein, MD (chairperson),
The Johns Hopkins Medical Institutions, Baltimore, MD; John
Srigley, MD, Laboratory Medicine, the Credit Valley Hospital,
Mississauga, Canada; David Grignon, MD, Indiana University
Medical Center, Indianapolis; and Peter Humphrey, MD, PhD,
Washington University School of Medicine, St Louis, MO.
Am J Clin Pathol 2008;129:24-30
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ADASP / REPORTING PROSTATE CARCINOMA
Address reprint requests to Dr Epstein: Surgical Pathology,
The Johns Hopkins Hospital, 401 N Broadway St, Room 2242,
Baltimore, MD 21231.
References
1. Eble JN, Sauter G, Epstein JI, et al. Pathology and Genetics of
Tumours of the Urinary System and Male Genital Organs. Lyon,
France: IARC Press; 2004:162-192. World Health Organization
Classification of Tumours.
2. Epstein JI, Allsbrook WC, Amin MB, et al. The 2005
International Society of Urological Pathology (ISUP)
consensus conference on Gleason grading of prostatic
carcinoma. Am J Surg Pathol. 2005;29:1228-1242.
3. Gleason DR, Mellinger GT, the Veterans Administration
Cooperative Urological Research Group. Prediction of
prognosis for prostate adenocarcinoma by combined histological
grading and clinical staging. J Urol. 1974;111:58-64.
4. Young RH, Srigley JR, Amin MB, et al. Tumors of the Prostate
Gland, Seminal Vesicle, Male Urethra and Penis. Washington,
DC: Armed Forces Institute of Pathology; 2000. Atlas of Tumor
Pathology; Third series, Fascicle 28.
5. Amin M, Boccon-Gibod L, Egevad L, et al. Prognostic and
predictive factors and reporting of prostate carcinoma in
prostate needle biopsy specimens (2004 WHO-sponsored
International Consultation Consensus). Scand J Urol Nephrol.
2004;39(suppl 216):20-33.
6. Epstein JI. The evaluation of radical prostatectomy specimens:
therapeutic and prognostic implications. Pathol Annu.
1991;26:159-210.
7. Epstein JI, Amin M, Boccon-Gibod L, et al. Prognostic factors
and reporting of prostate carcinoma in radical prostatectomy
and pelvic lymphadenectomy specimens (2004 WHOsponsored International Consultation Consensus). Scand J
Urol Nephrol. 2004;39(suppl 216):34-63.
8. Ohori M, Kattan M, Scardino PT, et al. Radical prostatectomy
for carcinoma of the prostate. Mod Pathol. 2004;17:349-359.
9. Humphrey PA, Walther PJ. Adenocarcinoma of the prostate,
I: simple sampling considerations. Am J Clin Pathol.
1993;99:746-759.
10. Aydin H, Tsuzuki T, Hernandez D, et al. Positive proximal
(bladder neck) margin at radical prostatectomy confers a
higher risk of biochemical progression. Urology. 2004;64:551555.
11. Grignon DJ, Sakr WA. Pathologic staging of prostate
carcinoma: what are the issues? Cancer. 1996;78:337-340.
12. Harnden P, Shelley MD, Clements H, et al. The prognostic
significance of perineural invasion in prostatic cancer biopsies:
a systematic review. Cancer. 2007:109:13-24.
13. Epstein JI, Herawi M. Prostate needle biopsies containing
prostatic intraepithelial neoplasia or atypical foci suspicious for
carcinoma: implications for patient care. J Urol. 2006;175:820834.
14. May F, Hartung R, Breul J. The ability of the American Joint
Committee on Cancer Staging system to predict progressionfree survival after radical prostatectomy. BJU Int. 2001;
88:702-707.
15. Freedland SJ, Partin AW, Epstein JI, et al. Biochemical failure
after radical prostatectomy in men with pathologic organconfined prostate cancer: pT2 versus pT2b. Cancer.
2004;100:1646-1649.
16. Eichelberger LE, Cheng L. Does pT2b prostate cancer exist?
critical appraisal of the 2002 TNM classification of prostate
cancer. Cancer. 2004;100:2573-2576.
Association of Directors of Anatomic and Surgical Pathology
Final Anatomic Diagnosis Checklist
Prostate Carcinoma
Accession No.:
Part No(s).:
Date:
Site
Operation
Patient Name:
Organ
Prostate gland
Prostate gland
Radical prostatectomy
Radical prostatectomy with right and left pelvic
and lymphadenectomy
Other:
Primary Tumor Diagnosis (Required)
Adenocarcinoma (not otherwise specified)
Mucinous adenocarcinoma
Prostatic duct adenocarcinoma
Small cell carcinoma
Adenosquamous carcinoma
Sarcomatoid carcinoma
Squamous cell carcinoma
Other:
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A. Gleason score: ____+ ____ = ____/10 with tertiary pattern ____ (if present)
Gleason Grading System
1
Single, separate, closely packed, uniform fairly large glands with a margin delineating the edge of tumor
2
Single, separate fairly large glands that are less uniform and more loosely arranged, with a less definite margin
3
Single, separate, but variably sized and shaped glands that may be widely separated and have a poorly delineated margin
Sharply circumscribed, rounded tumor with a cribriform pattern of the same size as normal glands
4
Fused glands
Poorly formed glands
Irregular or large cribriform glands
Hypernephromatoid pattern
5
Single cells
Sheets of cells
Cords of cells
Tumor with central comedonecrosis
Note: It is required that only the dominant tumor nodule is assigned a Gleason score with an option to assign a Gleason score to other major tumor nodules. The dominant
nodule is typically the largest tumor, which is also the tumor with the highest stage and highest grade. In the unusual occurrence of a nondominant nodule (ie, smaller
nodule) that is of higher stage or highest grade, one should also assign a grade to that nodule.
B. Location of tumor (Required)
Tumor predominantly involves the _______ lobe (specify laterality).
Tumor involves both lobes.
Note: Only dominant tumor(s) should be categorized. Small multifocal tumor foci should not be factored in unless they are the only or highest grade or highest stage tumor in
the prostate.
C. Extent of tumor
Tumor is confined to the prostate (lacks extraprostatic extension).
Tumor demonstrates extraprostatic extension
with unilateral extraprostatic extension (specify laterality).
bilateral extraprostatic extension.
Tumor invades into muscular wall of the seminal vesicle(s) (specify laterality).
Extraprostatic extension cannot be determined since the outer border of the prostate is microscopically not intact (capsular incision is
present, _______ specify laterality).
Margins of Excision (Required)
(Specify status of bladder base, apical margins, vas deferens margins, and peripheral margins.)
Bladder base margin is free of tumor.
Apical margin is free of tumor.
Bladder base and apical margins are free of tumor.
Vas deferentia margins are free of tumor.
Tumor is present at the apical margin.
Tumor is present at the bladder base margin.
Tumor is present at left/right vasa deferens margin.
Tumor is present at the peripheral margin in an area of extraprostatic extension at aspect of specimen (specify site[s] of involvement
such as anterior, posterior, left, or right).
Tumor is present at the peripheral margin in an area of capsular incision at aspect of specimen (specify site[s] of involvement such as
anterior, posterior, left, or right).
Note: All of the following lymph node groups will not be identified in most cases. However, appropriate designations are provided below.
Lymph Nodes, right pelvic
A. Number examined __________
B. Number positive ____________
C. Comment ___________________________________________________________
Lymph Nodes, left pelvic
A. Number examined __________
B. Number positive ____________
C. Comment ___________________________________________________________
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Lymph Nodes, right obturator
A. Number examined __________
B. Number positive ____________
C. Comment ___________________________________________________________
Lymph Nodes, left obturator
A. Number examined __________
B. Number positive ____________
C. Comment ___________________________________________________________
Additional Tumor Features (Optional)
A.
B.
C.
D.
Tumor involves approximately ______ % of the prostate gland (alternate measurements of tumor volume can be used).
Vascular invasion:
Identified
Not identified
Extent of extraprostatic spread:
Focal
Nonfocal
Extent of margin positivity:
Focal
Nonfocal
Additional Findings and Comments
Prostatic intraepithelial neoplasia (PIN), high grade
Adenosis
Basal cell hyperplasia
Atrophy
Treatment-related changes
Other:
Ancillary Studies (Optional)
Special stains are performed, the results are as follows:
A. _____________________________________________________________________
B. _____________________________________________________________________
C. _____________________________________________________________________
D. _____________________________________________________________________
Interpretation _________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
Immunohistochemical studies are performed, the results are as follows:
A. _____________________________________________________________________
B. _____________________________________________________________________
C. _____________________________________________________________________
D. _____________________________________________________________________
Interpretation _________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
pTN Stage (Required)
A. Primary tumor
pT2
Tumor confined within the prostate.
pT2x (or pT2+) Tumor is organ-confined except in an area of capsular incision where it cannot be determined.
Tumor extends out of the prostate.
pT3a Tumor demonstrates extraprostatic extension without seminal vesicle invasion.
pT3b Tumor demonstrates extraprostatic extension and invades seminal vesicle.
Tumor is fixed or invades adjacent structures other than the seminal vesicles, such as bladder neck (grossly), external sphincter,
rectum, levator muscles, and/or is fixed to the pelvic wall.
pT3
pT4
Note: A microscopically positive bladder neck margin is pT3.
Note: If surgical margin(s) is positive for carcinoma, this should be indicated by the designation R1 in the pT stage, eg, pT3(R1).
B. Regional lymph nodes
pNX
pN0
pN1
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30
Regional lymph nodes cannot be assessed
No regional lymph node metastasis
Metastasis in regional lymph node or nodes
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© American Society for Clinical Pathology